Independent Histology Service LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

INDEPENDENT HISTOLOGY SERVICE LLC

Practice address

930 S Homestead Dr
Woodland Hills, UT 84653-2084

Phone

(801) 423-2334

Fax

(801) 221-1899

NPI assigned

Oct 25, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Leslie D. Hendricksen, HT ASCPNPI 1326120981

Title

Owner Director

Phone

(801) 423-2334

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Leslie D. Hendricksen, HTASCP

  • Histology Specialist/Technologist
  • Orem, UT
  • NPI 1326120981
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1386728178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 S HOMESTEAD DR",
            "city": "WOODLAND HILLS",
            "state": "UT",
            "postal_code": "846532084",
            "telephone_number": "801-423-2334",
            "fax_number": "801-221-1899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 S HOMESTEAD DR",
            "city": "WOODLAND HILLS",
            "state": "UT",
            "postal_code": "846532084",
            "telephone_number": "801-423-2334",
            "fax_number": "801-221-1899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENT HISTOLOGY SERVICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HENDRICKSEN",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "OWNER DIRECTOR",
        "authorized_official_telephone_number": "801-423-2334",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "HT ASCP"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "UT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy E Bartholomew, ATC
• Daniel S. Mehr, M.D., P.C.
• Kaycie Johanna Davis, APRN, PMHNP-BC
• Kaila Fredrick
• Randal Boyd Gibb, MD
• Scott Innes
• Bill Clifford Marshall, PH.D.
• Debra Theobald McClendon, PH.D.
• Madyson Marie Meeks
• Daniel Scott Mehr, M.D.

• Clinical Medical Laboratory in Woodland Hills, UT
• Providers in Woodland Hills, UT by specialty
• Clinical Medical Laboratory in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.